Get Arseba

Filling out the Arseba online allows users to efficiently manage their dental enrollment or changes. This guide provides a clear, step-by-step approach to ensure you complete the form accurately and efficiently.

Follow the steps to complete the Arseba form online.

1. Click ‘Get Form’ button to access the Arseba document and open it in the editor.
2. Enter your agency name in the specified field to indicate your workplace.
3. Fill in your last name, first name, middle initial, and Social Security number (SSN).
4. Provide your personnel number, street address, city, state, ZIP code, phone number, and email address.
5. Indicate your date of hire and date of birth using the MM/DD/YY format.
6. Select your gender by marking the appropriate box: Male or Female.
7. Choose your marital status: Single or Married.
8. In the coverage changes section, select the type of coverage you are applying for: Base Dental or Premium Dental, alongside the corresponding plan option.
9. Check the box next to the reason for your change, such as Open Enrollment, New Hire, or Status Change.
10. List all members to be enrolled or affected by the change by filling in their last names, first names, middle initials, genders, and birthdates.
11. Review the authorization section and provide your signature and date to confirm your consent for information disclosure.
12. Complete the certification section by affirming the accuracy of the information provided.
13. If applicable, indicate your approval for payroll deductions by signing.
14. Once all sections are completed, save changes, print, or download the form for your records.

Complete your Arseba online and ensure your dental coverage is managed effectively.